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COVID-19 pandemic:Building organisational flexibility to scale transplant programs

World Journal of Transplantation 2020年第10期10卷 277-282页

作者： jeevan prakash gopal Vassilios E Papalois Imperial College Renal and Transplant Center Hammersmith HospitalImperial College Healthcare NHS TrustLondon W120HSUnited Kingdom Imperial College Renal and Transplant Center Department of Surgery and CancerHammersmith HospitalImperial College Healthcare NHS TrustLondon W120HSUnited Kingdom

The prevailing coronavirus disease 2019 pandemic has challenged our lives in an unprecedented *** pandemic has had a significant impact on transplantation *** logistics of travel restrictions,stretching of available resources,unclear risk of infection in immunosuppressed transplant recipients,and evolving guidelines on testing and transplantation are some of the factors that have unfavourably influenced transplant *** must begin to build organisational flexibility in order to restart transplantation so that we can be mindful stewards of organ donation and sincere advocates for our *** a culture of honesty and transparency(with patients,families,colleagues,societies,and authorities),keeping the channels of communication open,working in collaboration with others(at local,regional,national,and international levels),and not restarting without rethinking and appraising all elements of our practice,are the main underlying principles to increase the flexibility.

关键词： Organisational flexibility Clinical decision making COVID-19 Organ donation Care delivery Transplantation

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Renal transplantation in gigantism: A case report

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World Journal of Transplantation 2022年第4期12卷 65-71页

作者： jeevan prakash gopal Sotirios Charalampidis Jinpo Xiang Frank JMF Dor Vassilios E Papalois Imperial College Renal and Transplant Center Imperial College Healthcare NHS TrustHammersmith HospitalLondon W120HSUnited Kingdom Imperial College School of Medicine Imperial CollegeLondon W120HSUnited Kingdom Department of Surgery and Cancer Imperial CollegeLondon W120HSUnited Kingdom

BACKGROUND Gigantism,characterized by excessive growth and height is due to increased secretion of growth hormone,most commonly from a pituitary *** addition to the surgical and anesthetic complexity,the extreme stature of these patients presents a unique challenge for kidney transplantation in deciding whether to proceed with a single or dual kidney *** lack of relevant literature further adds to the *** SUMMARY A 45-year-old patient with untreated gigantism and end stage renal failure on renal replacement therapy was waitlisted for a deceased donor dual kidney transplantation due to the extreme physical stature(Height-247 cm and weight-200 kg).He was offered 2 kidneys from a 1-0-1 HLA mismatched 24-year-old DCD donor(Height-179 cm and weight-75 kg),and was planned for a bilateral retroperitoneal implantation into the recipient external iliac *** immunosuppression consisted of alemtuzumab induction(50 mg)and steroidfree maintenance with *** donor’s right kidney was uneventfully implanted extra-peritoneally into the right external iliac *** contralateral exposure,the left common and external iliac arteries were ectatic and frail.A complex vascular reconstruction was not preferred in order to preserve the arterial supply to the left lower limb,to minimise the cold ischemia time and prevent additional warm ischemic insult to the second ***,it was decided not to proceed with dual *** concerns of nephron mass insufficiency,the graft function was remarkable with a serum creatinine of 120μmol/L within a month from transplantation and 94μmol/L at 1-year post transplantation,and without *** To our knowledge,this is the first case report on kidney transplantation in *** it is believed that dual kidney transplantation is ideal,a single kidney transplantation from an appropriately selected donor can provide sufficient functioning nephron mass in patients with

关键词： Gigantism Giantism Renal transplantation Kidney transplantation Pituitary adenoma Case report

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Anticoagulation in simultaneous pancreas kidney transplantation - On what basis?

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World Journal of Transplantation 2020年第7期10卷 206-214页

作者： jeevan prakash gopal Frank JMF Dor Jeremy S Crane Paul E Herbert Vassilios E Papalois Anand SR Muthusamy Imperial College Renal and Transplant Center Imperial College Healthcare NHS TrustHammersmith HospitalLondon W120HSUnited Kingdom Department of Surgery and Cancer Imperial CollegeLondon W120HSUnited Kingdom

BACKGROUND Despite technical refinements,early pancreas graft loss due to thrombosis continues to *** coagulation tests(CCT)do not detect hypercoagulability and hence the hypercoagulable state due to diabetes is left ***(TEG)is an in-vitro diagnostic test which is used in liver transplantation,and in various intensive care settings to guide *** is better than CCT because it is dynamic and provides a global hemostatic profile including *** To compare the outcomes between TEG and CCT(prothrombin time,activated partial thromboplastin time and international normalized ratio)directed anticoagulation in simultaneous pancreas and kidney(SPK)transplant *** A single center retrospective analysis comparing the outcomes between TEG and CCT-directed anticoagulation in SPK recipients,who were matched for donor age and graft type(donors after brainstem death and donors after circulatory death).Anticoagulation consisted of intravenous(IV)heparin titrated up to a maximum of 500 IU/h based on CCT in conjunction with various clinical parameters or directed by TEG *** loss due to thrombosis,anticoagulation related bleeding,radiological incidence of partial thrombi in the pancreas graft,thrombus resolution rate after anticoagulation dose escalation,length of the hospital stays and,1-year pancreas and kidney graft survival between the two groups were *** Seventeen patients who received TEG-directed anticoagulation were compared against 51 contemporaneous SPK recipients(ratio of 1:3)who were anticoagulated based on *** graft losses occurred in the TEG group,whereas 11 grafts(7 pancreases and 4 kidneys)were lost due to thrombosis in the CCT group(P=0.06,Fisher’s exact test).The overall incidence of anticoagulation related bleeding(hematoma/gastrointestinal bleeding/hematuria/nose bleeding/re-exploration for bleeding/post-operative blood transfusion)was 17.65%in the TEG group and 45

关键词： Anticoagulation Pancreas transplantation Thromboelastography Thrombosis Hypercoagulability

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Relationship between serum copper and protein thiols in hyperlipidemic patients

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海南医学院学报 2010年第10期16卷 1266-1268页

作者： jeevan K Shetty Suresh Babu Sudeshna Tripathy Mungli prakash Department of Biochemistry Kasturba Medical CollegeManipal University Deartment of Biochemistry JJM Medical CollegeDavanagere Indian institute of Science Bangalore Department of Biochemistry and Genetics St.Mathews UniversitySchool of MedicineGrand Cayman

Objective:To measure serum copper and protein thiols along with lipid profile in hyperlipidemic patients and to establish the relationship between serum copper,protein thiols and lipid profile ***: The study group consisted of 26 newly diagnosed hyperlipidemic patients not associated with any other systemic diseases and 26 age and sex matched healthy *** lipid profile was done by enzymatic method using automated *** copper and protein thiols were measured ***: Serum copper and protein-SH levels were significantly decreased in cases(P<0.01,P<0.01) compared to *** copper correlated positively with protein thiols(r=0.800,P<0.01) and negatively with LDL cholesterol(r=-0.351 P<0.05).Conclusion: Serum copper and protein thiols were decreased in hyperlipidemia and they correlated positively indicating protective role of copper in preventing homocysteinylation of protein and hence in preventing atherosclerosis.

关键词：糖尿病高血脂高血糖临床

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Serum paraoxonase activity and protein thiols in patients with hyperlipidemia

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海南医学院学报 2009年第2期15卷 111-113页

作者： Mungli prakash jeevan K Shetty Sudeshna Tripathy Pannuri Vikram Manish Verma Department of Biochemistry Kasturba Medical CollegeManipalKarnataka

Objective: In the present study we evaluated the paraoxonase activity and protein thiols level in south Indian population with newly diagnosed ***: The study was conducted on 55 newly diagnosed hyperlipidemic patients and 57 healthy *** paraoxonase activity and protein thiols were estimated by spectrophotometeric method and lipid profile by enzymatic kinetic assay ***: Serum paraoxonase activity,protein thiols and high density lipoprotein levels were low and total cholesterol,triglycerides and low density lipoprotein levels were high in patients with hyperlipidemia compared to healthy controls(P<0.01).Serum paraoxonase activity correlated positively with protein thiols and high density lipoprotein(P<0.01).Conclusion: Decreased paraoxonase activity and protein thiols were found in patients with *** may indicate the susceptibility of this population to accelerated atherogenesis and protein oxidation.

关键词：血清磷酶蛋白质高血脂临床分析治疗方法

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Association of bilirubin and protein thiols in relation to copper and ceruloplasmin in hyperbilirubinemic patients

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海南医学院学报 2009年第1期15卷 40-44页

作者： Mungli prakash jeevan K Shetty Roshan D' Souza Suhasa Upadhya Vijay Kumar Departmentt of Biochemistry Kasturba Medical College

Objective:Bilirubin is a double edged sword in biological system,acting as a toxic molecule and *** bilirubin is proved to show antioxidant activity in vitro and in *** the current work we tried to know the relationship between both conjugated and unconjugated bilirubin with copper and protein thiols in patients with ***:Study was conducted on 56 hyperbilirubinemic cases and 56 healthy *** copper,ceruloplasmin,protein thiols,total bilirubin,conjugated and unconjugated bilirubin,unconjugated bilirubin/albumin ratio,total protein,albumin,AST,ALT and ALP were ***:There was significant increase in serum copper,total bilirubin,conjugated and unconjugated bilirubin,unconjugated bilirubin/albumin ratio,AST,ALT,and ALP,and decrease in serum ceruloplasmin,protein thiols,total protein,and albumin in hyperbilirubinemic cases when compared to healthy *** bilirubin correlated positively with liver enzymes AST and ALP,and negatively with protein thiols,total protein and *** bilirubin correlated positively with *** thiols correlated negatively with copper and positively with ceruloplasmin,and also correlated negatively with liver enzymes like AST,ALT and ALP,and positively with total protein and ***:Combination of elevated levels of trace elements like copper and availability of reducing agent like bilirubin may prove deleterious by generating free radicals.

关键词：蛋白质硫藤黄菌素血浆铜蓝蛋白抗氧添加剂

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